Aged Care Royal Commission Update – August & September

Written by Ilsa Bird – Sector Support Coordinator

August and September Hearings

During August and September, four hearings were held in Sydney. These hearings included:

1. The response to COVID in aged care
2. Accommodation
3. Home Care
4. Funding, financing and prudential regulation

Read below for a summary of the key points presented at each hearing.

The response to COVID in aged care: 10-13 August

This hearing was held to examine the response to the COVID-19 pandemic in aged care, and what can be learned from this experience for responding to future pandemics, infectious disease outbreaks or other emergencies.

On the final day of the hearing Mr Peter Rozen, Counsel Assisting, declared three key points regarding the COVID response in aged care:

1. the sector was presented with an unprecedented challenge
2. everyone involved, both in aged care homes and in government has worked and is working very diligently to respond to that challenge
3. none of the problems that have been associated with the response of the aged care sector to COVID-19 were unforeseeable.

He stated that the sector was not prepared for COVID in March and is still not prepared now. Mr Rozen attributed the lack of preparedness to several factors including:

• gaps in workforce numbers and training, including the likelihood that more staff would be necessary to deliver care during the pandemic
• access to PPE and training in its proper use
• the lack of clinical skills especially in infection control
• personal care workers who lack the foundational standards about infection control that are taken for granted in the health sector
• the challenges of achieving high-level infection control in a home-like setting
• inefficiencies in governance and managerial ability in parts of the sector
• the significant operational differences between aged care facilities and hospitals
• the challenges associated with the interface with the state health sector

Although the Australian mortality rate is low in relation to other countries, there have been 220 deaths of residents in residential aged care due to COVID-19. This represents 70 per cent of all the country’s COVID-19 deaths. On this measure, Mr Rozen declared that “we’re one of the worst performing countries in the world”.

Following this hearing, the Royal Commission released a report titled Aged Care and COVID-19 which outlines six recommendations for immediate action including:

Recommendation 1 – The Australian Government should report to Parliament by no later than 1 December 2020 on the implementation of these recommendations.

Recommendation 2 – The Australian Government should immediately fund providers that apply for funding to ensure there are adequate staff available to allow continued visits to people living in residential aged care by their families and friends.

Recommendation 3 – The Australian Government should urgently create Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to people in aged care during the pandemic.

Recommendation 4 – The Australian Government should establish a national aged care plan for COVID-19 through the National Cabinet in consultation with the aged care sector.

Recommendation 5 – All residential aged care homes should have one or more trained infection control officers as a condition of accreditation. The training requirements for these officers should be set by the aged care advisory body we propose.

Recommendation 6 – The Australian Government should arrange with the States and Territories to deploy accredited infection prevention and control experts into residential aged care homes to provide training, assist with the preparation of outbreak management plans and assist with outbreaks.

The Australian Government has responded through several budget measures in the Federal Budget announced on 6 October 2020. Read about the budget response here.

For more information about the COVID response in aged care, download the full report or view our webinar ‘What can Home and Community care providers learns from the COVID response in Residential Care’ here.

Accommodation: 13-14 August

This hearing was held to explore the topic of accommodation with issues to be considered including:

• appropriate building and design standards for aged care delivery
• physical design and models of residential aged care, including ‘small home models’ and dementia-friendly design
• access to secure housing for aged care delivery
• incentivising movement to alternative accommodation for the provision of aged care services
• innovative accommodation models for ageing in place and interaction with aged care supports.

On the final day of the hearing, Mr Richard Knowles, Counsel Assisting, summarised the evidence presented. He concluded the following key points:

1. there is far from enough suitable accommodation for older people to age in place and as necessary receive aged care services
2. greater compliance is required regarding appropriate design standards whether that be generally for buildings in the community, or more particularly, in respect of residential aged care
3. incentive is required to transition to small household living models for residential aged care providers which could be done through additional supplements.
4. more innovative accommodation models are required such as cohousing

To see more information about accommodation and aged care, download Research Paper 7 – Models of Integrated Care Health and Housing here.

Home Care: 31 Aug- 2 Sep

This hearing was held to explore the issues related to home care including:

• employment and engagement arrangements for home care workers
• qualifications and training for home care workers
• safeguards for older people receiving care in their homes
• regulation of aged care services delivered to people in their homes and in the community.

On the final day of the hearing, Mr Peter Gray, Counsel Assisting, outlined six major themes that emerged from the evidence and witness testimony.

1. How best to respect the preferences and choices and improve control and enable independence of the people who are seeking support and care in their own homes. Person-centred care must be improved, and older people must be active participants in the service delivery system.
2. How best to transition to an integrated program to reduce the level of institutionalisation. The system needs to recalibrate to be able to ensure that with the more complex needs being catered for in a home environment, the capabilities and the framework are there to ensure that that’s done safely and appropriately.
3. How best to build the capacity and the capability of providers and the workforce to provide the services that would be needed across the broad-spectrum of services for home and community support and care. There is importance to invest in learning and development and it is critical that careers in aged care are attractive and offer career progression to higher positions. Mr Gray also discussed some of the benefits and drawbacks of a direct employment model and made recommendations for increased regulation of direct employment platforms.
4. How best to ensure that the services provided will be safe and will be of high quality. Mr Gray recommended a phased implementation of any new regulatory measures.
5. How best to ensure that all of this is achievable for the long term in a sustainable manner as in Australia, the allocation of resources is skewed towards the mode of residential aged care rather than home care.

Following the hearing about Home Care the Commission released Research Paper 11 – Aged Care Reform: Projecting Future Impacts. This paper was prepared by Deloitte Access Economics which examines key aged care funding reforms the Royal Commission is considering. The modelling indicates reform would need new funding equivalent to a 1 percentage point increase in income tax rates. Download Research Paper 11 here.

Funding, financing, and prudential regulation: 14-22 Sep

This hearing explored the financing and sustainability of future improvements to the aged care system, the appropriate funding model or models to support the delivery of aged care services, and the prudential regulation of aged care providers.

In his opening statement, Mr Peter Gray, Counsel Assisting, stated “The topic is large and technical. Funding is vitally important, not only because it’s critical to capability to provide aged care but also because the way it is administered can have a profound effect on quality.”

Over the course of the hearing, the commission heard evidence from expert witnesses regarding regulation, funding and system reform. Recommendations included:

• An Independent pricing authority for Home Care, like the Independent Hospital Pricing Authority, who either set price or make price recommendations.
• ACFI style funding for Home Care to allow people on higher level packages to remain at home.
• A deposit system where the government pay a deposit to a provider to cover the cash flow and afterwards, it is offset against ongoing fees.
• Increased empowerment for APRA to improve financial reporting in home care.
• A three-yearly indexation cycle to provide funding certainty and facilitate financial planning.
• Primary, secondary, and tertiary aged care streams that can be accessed simultaneously. The primary aged care stream includes services that can be accessed directly without going through a formal comprehensive assessment on referral from somewhere like a GP or a hospital discharge planner. The secondary stream is for people living at home with higher level care needs and the ongoing aspect of this stream involves hands on personal care, allied health, restorative care, and centre based transition programs. The tertiary aged care service stream is for those who are unable to live at home and includes residential care, cluster housing and community aged care hospice, residential respite services and transition care.
• A Longevity Levy: A HECS style funding model proposed by former Prime Minister, Paul Keating. Mr Keating suggested that every Australian be given a loan advance to pay for aged care services then upon death, the loan is recuperated from their estate.

For more information about these hearings or to view the transcripts, please click here.

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